Single Incision Laparoscopic Ostomy Surgery-our Initial Experience

Single incision laparoscopic surgery (SILS) is becoming more and more popular as surgeons gain experience with this new technique. Single incision laparoscopy provides better cosmetic results and may lead to less post operative pain and a lower incidence of incisional hernias due to the fewer number of incisions. SILS has been utilized for numerous procedures including appendectomy, cholecystectomy, colectomy, Nissen fundoplication, splenectomy, and gastrectomy to name just a few. To date, there has been only one report of single incision colostomy surgery. We report our initial experience with single incision colostomy surgery including both the creation and reversal of ostomies. We performed SILS colostomy creation in five patients (age 44-92, one female, four male, avg blood loss 10 ml, indications: soiling of large perineal wound-3, prior to pelvic exenteration-1, incontinence after treatment for rectal cancer-1) one SILS ileostomy reversal after subtotal colectomy (58 y/o male), and one SILS colostomy (59 y/o female) reversal after perforated sigmoid diverticulitis. In those patients undergoing colostomy creation, the patient was place in supine position. The ostomy site was previously marked on the abdomen in the left mid abdomen. The ostomy defect was created in the standard fashion by removing a circle of skin and then creating a cruciate incision through the fascia allowing passage of two fingers. A small Alexis wound protector is placed into the abdomen through this defect. The wound protector is then covered with a small latex free glove. A 12 mm and two five mm trocars are placed through three alternating fingers of the glove and secured with sterile strips. The abdomen is then insufflated through this device. The abdomen is explored and the sigmoid colon is identified. Mobilization is undertaken to allow sufficient length for the ostomy. The colon is then transected with an endoscopic GIA stapler. The proximal end is grasped with an atraumatic instrument and the distal aspect of the colon is left as a Hartmann’s pouch. The wound protector is removed and the proximal colon is brought out through the fascial defect. The stoma is matured in the standard fashion. For the two ostomy reversals, the procedure is essentially reversed. The patients are placed in modified lithotomy position. The stoma is then mobilized until it is free from the fascia. An appropriately sized EEA anvil is placed in the bowel and then placed in the abdomen. The “glove port” device is created and secured to an Alexis wound protector which has been placed through the stoma site. Adhesiolysis is performed as needed. Under direct vision, an anastomosis is created through the rectum. An air test under saline irrigation is performed. The ostomy site is closed with permanent suture for the fascia and staples for the skin. Single incision laparoscopic surgery is feasible for both the creation and reversal of ostomies. SILS offers all the benefits of laparoscopy while leaving no visible abdominal incision when creating an ostomy and no new incisions when reversing an ostomy.